Marie Caudill is a professor at Columbia University and an expert on the impact of choline on maternal and infant health. She says choline hasn't been a nutrition focus until now because "it was assumed for a long time that because our bodies make choline, we don't need to worry about our dietary intake.
"Choline is critical to so many metabolic pathways, so our body does have the ability to make some. During pregnancy, the body's ability to produce choline is ramped up by estrogen. However, our studies and others have shown there is depletion of choline during this life stage."
Taylor Wallace is an affiliate professor in the Department of Nutrition and Food Studies at George Mason University who worked on a recent analysis of choline intake in the United States. He says, "There isn't enough awareness about choline even among health-care professionals because our government hasn't reviewed the data or set policies around choline since the late '90s."
Health benefits of choline
Just as vitamin D plays a supportive role in calcium absorption, choline helps omega-3 fatty acids and B vitamins such as folate function as they should. Here are the potential benefits of choline under study.
• Choline during pregnancy and breastfeeding: Most women of child-bearing age are well aware of the importance of folate for a baby's developing nervous system, yet many aren't aware that choline is also needed.
Pregnant women are also concerned about getting enough DHA, since a growing body of research has linked prenatal consumption of this fatty acid to improved cognition later in life. Choline plays a similar role as DHA in being required for membranes of nervous system cells. According to Caudill, "Studies show if you give pregnant women more choline, the mother will make more choline that contains DHA and this will be specifically directed towards the placenta and the baby."
In animal studies, getting enough choline prenatally and during childhood is linked to improved learning, visual-spatial skills and memory later in life.
Caudill notes that "when pregnant women supplement with choline, their babies are born with lower levels of the stress hormone cortisol. This could have lifelong beneficial effects in terms of reducing chronic disease risk."
• Brain and heart health: Did you misplace your keys again or forget to call someone back? Choline plays a role in processing and storing memories, functions that are critical for learning and knowledge retention. In animal studies, having enough choline appears to have an impact on activating parts of the brain responsible for memory.
Choline is one of the building blocks for acetylcholine, a neurotransmitter that functions as a chemical messenger in the brain. Choline is also part of the membrane of all cells and plays a role in signaling between cells.
Because acetylcholine is needed for nerves to signal muscles such as the heart, choline is needed to regulate the heart rate at rest.
• Choline and the aging brain: A new area of interest is whether improving choline intake could prevent cognitive decline as we age. Researchers have observed that high blood levels of the amino acid homocysteine in older adults is linked to poor performance on cognitive tasks and functions such as object naming, concentration and language.
Choline intake appears to have an inverse relationship with homocysteine levels, spurring further investigation into the role choline may play in brain health in older adults.
• Liver health: Choline helps move fat out of the liver, helping prevent nonalcoholic fatty liver disease. In doing so, choline also frees up the liver to perform its key functions of filtering and detoxification and turning food into energy.
• Sports performance: Choline is needed for the brain to signal working muscles. Not having enough choline - and therefore acetylcholine - during exercise could slow down the message from your brain to your muscles to contract, potentially making you tire more quickly during endurance exercise.
In animal models, when muscles don't get enough choline, muscle cells start to break down. The movement of fat out of the liver to be used as energy also decreases when choline levels are too low.
How to get enough choline
The recommended daily intake for choline is 550 mg a day.
Here's what that would look like in food:
Breakfast:
2 whole eggs
Lunch:
3 oz chicken breast
1/3 cup lima beans
Dinner:
1 sole fillet: 102 mg
1 cup Brussels sprouts
Obviously your diet will and should have more variety than this day to day. Overall, include a variety of meats and green vegetables in your diet to help you meet your choline needs. To get more choline, choose egg-based dishes such as frittatas and quiche. Beef, chicken and fish, as well as Brussels sprouts and broccoli, also contain some choline.
If you aren't already eating your egg yolks, you should be. A recent meta-analysis and reviews of the research suggest that eating egg yolks regularly doesn't increase the risk of coronary heart disease or stroke. Having two whole eggs a day provides half of the choline most people need.
As awareness about choline continues to rise, you'll start to see more choline-fortified foods on grocery store shelves. You may also consider taking a choline supplement. Unfortunately, choline is not in your multivitamin or even prenatal vitamins.
Caudill advises that pregnant and lactating women eat two eggs (including yolks) a day to help boost choline levels. For those women who don't eat eggs or other animal protein, taking a choline supplement of 350 mg a day is "highly advisable."
Wallace says most people will need a choline supplement. "According to the 2015 Dietary Guidelines for Americans, modeling of different healthy diet patterns found people would still fall short of their daily choline needs."
Because everyone will be getting various amounts of choline through their diets, talk to a registered dietitian or your physician about whether you need a choline supplement and how much to take.
For infants, formulas are fortified with choline. If you are breastfeeding, speak to your health-care provider about whether you should supplement with choline.
The good news: You'll start to see choline in some Nutrition Facts tables, as the FDA has made it a nutrient that can voluntarily be put on the new food labels. Soon you'll be able to identify which packaged foods are rich in choline at a glance.
